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City of Woodburn Community Development Department 270 Montgomery Street Woodburn, OR 97071 Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] City of Woodburn Uniform Application – Revised September 2023 Page 1 of 2 OFFICE USE ONLY File Number(s): Uniform Application Project Name: Address(es): Tax Lot Applicant Name: Title: Phone: Firm: Mailing Address: Email: Applicant’s Representative/Project Manager Name: Title: Phone: Firm: Mailing Address: Email: Landowner Name: Title: Phone: Firm: Mailing Address: Email: Architect Name: Title: Phone: Firm: Mailing Address: Email: Civil Engineer Name: Title: Phone: Firm: Mailing Address: Email: Landscape Architect Name: Title: Phone: Firm: Mailing Address: Email: Visit the City of Woodburn Planning webpage for the most current forms and applications. Thoroughbred Express Car Wash 1299 N Pacific Highway, Woodburn, OR 97071 051W08DB02400 Conner Hayes Director [PHONE REDACTED] Blitz Holdings 506 Second Avenue, Suite 1009, WA 98104 Keana Poach Assistant Planner [PHONE REDACTED] Core States Group 18215 72nd Avenue South, Kent, WA 98032 [EMAIL REDACTED] Woodburn Land LLC [PHONE REDACTED] 506 Second Avenue, Suite 1009, WA 98104 Logan Piburn Senior Project Architect [PHONE REDACTED] Core States Group 18215 72nd Avenue South, Kent, WA 98032 [EMAIL REDACTED] Nathan Machiela Senior Civil Project Manager [PHONE REDACTED] Core States Group 400 Columbia Point Drive, Suite 101-B, Richland, WA 99352 [EMAIL REDACTED] Jeff Varley Senior Landscape Architect [PHONE REDACTED] Core States Group 18215 72nd Avenue South, Kent, WA 98032 [EMAIL REDACTED] Docusign Envelope ID: 62CC356A-9E95-46E8-A9E7-48DFFEBCF58A ---PAGE BREAK--- City of Woodburn Uniform Application – Revised September 2023 Page 2 of 2 Requested Review(s): □Annexation □Comprehensive Plan Amendment □Conditional Use Permit □Design Review □Type I □Type II □Type III □Grading Permit □Partition or Subdivision, Preliminary □Other: □Partition or Subdivision, Final □Phasing Plan □Property Line Adjustment / Consolidation of Lots □Planned Unit Development (PUD), Preliminary □PUD, Final □RCWOD Permit □Significant Tree Removal Permit □Street Adjustment (formally EXCP) □Variance □Zoning Adjustment □Zoning Map Change Certification: I hereby declare that as applicant or landowner, I have read the foregoing application and know the contents of the application to be true. If applying on behalf of a corporation, Manager certifies that Manager has full power and authority (corporate or otherwise) to enter into this Agreement and to consummate the transactions contemplated by it. This Agreement has been duly authorized by all necessary action on the part of Manager and no other corporate or other action on the part of Manager is necessary to authorize the execution and delivery of this Agreement. The individual executing this Agreement for Manager has full authority to do so and thereby to bind Manager to its terms. If Applicant is different from Landowner, Applicant must also obtain Landowner certification. □Landowner certification attached in lieu of form signature. Landowner’s Signature Applicant’s Signature Print Name Print Name Date Date □Electronic versions of all application materials, which can be sent via zip folder in email or saved on a flash drive. Docusign Envelope ID: 62CC356A-9E95-46E8-A9E7-48DFFEBCF58A 9/25/2025 I 1:52 PM PDT Nick Cicero 9/25/2025 I 1:52 PM PDT Nick Cicero